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Florida Practitioner Disease Report Form (Rule 64D-3)

Florida practitioners use this one-page Department of Health form to notify the county health department of a reportable disease or condition under Rule 64D-3.029, Florida Administrative Code, and section 381.0031, Florida Statutes. A clinician meets it after suspecting or diagnosing a condition on Florida's practitioner list. The form itself prints that list and flags conditions that must be phoned in 24/7.

Who completes it

The health care practitioner who suspects or diagnoses the condition completes the whole form: patient information, medical information such as onset, hospitalization and treatment, and provider details. Lab results are attached rather than typed in.

Submitting and payment

How to submit it
Fax the form, with the medical records for the patient's infection, to the county health department where the patient resides. Conditions marked for immediate notification must also be phoned to the county health department, 24/7.
Who pays
The Florida Department of Health lists no fee or payment for practitioner disease reports.

Good to know

  • HIV and AIDS are reported on CDC 50.42A (13 and older) or 50.42B (under 13) to the county health department within two weeks of diagnosis, not on this form.
  • Cancer goes to the Florida Cancer Data System, and congenital anomalies and neonatal abstinence syndrome are captured through AHCA inpatient discharge data instead.
  • Registering for electronic case reporting (eCR) does not exempt a practice from reporting cases to its county health department.
  • Laboratory reporting rules differ. Practices doing point-of-care testing can report results through Florida's electronic laboratory reporting or its web portal once onboarded.

Get the official form

Download the current version from the source each time; forms change without notice.

Practitioner Disease Report Form

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Where do I send Florida's Practitioner Disease Report Form?

To the county health department where the patient resides, by fax with the medical records for the patient's infection. The Department of Health posts a county health department epidemiology contact list. Cancer, HIV and a few other conditions follow different routes printed on the form.

Which Florida conditions must be phoned in?

The reportable list printed on the form marks conditions to be reported immediately, 24/7 by phone, either upon initial suspicion or upon diagnosis. Phone those to the county health department rather than relying on a faxed form. Other conditions follow the timeframes in Florida's reportable diseases list for practitioners.

Does HIPAA prevent sending this report?

No. Florida law requires practitioners to report these conditions, and the Department of Health posts a HIPAA-exempt letter for providers with its disease reporting materials. Its reporting page also states that medical records must be made available for epidemiologic investigations.